Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial

M. Spadafora; L. Pace; L. Evangelista; L. Mansi; F. Del Prete; G. Saladini; P. Miletto; S. Fanti; S. Del Vecchio; L. Guerra; G. Pepe; G. Peluso; E. Nicolai; G. Storto; M. Ferdeghini; A. Giordano; M. Farsad; O. Schillaci; C. Gridelli; A. Cuocolo

doi:10.1007/s00259-018-4043-y

Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial

M. Spadafora, L. Pace, L. Evangelista, L. Mansi, F. Del Prete, G. Saladini, P. Miletto, S. Fanti, S. Del Vecchio, L. Guerra, G. Pepe, G. Peluso, E. Nicolai, G. Storto, M. Ferdeghini, A. Giordano, M. Farsad, O. Schillaci, C. Gridelli, A. Cuocolo

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and 18F-FDG PET/CT has proven to be more effective than CT alone. Pre-test risk stratification and clinical presentation of SPN could affect the diagnostic strategy. A relevant issue is whether thoracic segmental (s)-PET/CT could be implemented in patients with SPN. This retrospective multicenter study compared the results of FDG whole-body (wb)-PET/CT to those of s-PET/CT. Methods: 18F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. The thoracic part of wb-PET/CT, considered s-PET/CT, was compared to wb-PET/CT. Clinical and PET/CT variables were investigated for SPN characterization as well as for identification of patients in whom s-PET/CT could be performed. Histopathology or follow-up data were used as a reference. Results: In the study population, 36% had malignant, 35% benign, and 29% indeterminate SPN. 18F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. All patients with extra-thoracic metastases (n = 13) had thoracic lymph node involvement and highest 18F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT. Conclusion: Pre-test probability of malignancy can guide the diagnostic strategy of 18FDG-PET/CT in patients with SPN. In subjects with low-intermediate pretest probability s-PET/CT imaging might be planned in advance, while in those at high risk and with thoracic lymph node involvement a wb-PET/CT is necessary. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

Original language	English
Pages (from-to)	1908-1914
Number of pages	7
Journal	European Journal of Nuclear Medicine and Molecular Imaging
Volume	45
Issue number	11
DOIs	https://doi.org/10.1007/s00259-018-4043-y
Publication status	Published - Oct 11 2018

Keywords

fluorodeoxyglucose f 18, aged
Article
cancer risk
cancer test
clinical assessment
clinical effectiveness
cohort analysis
comparative study
controlled study
diagnostic test
distant metastasis
female
follow up
histopathology
human
intermethod comparison
lung metastasis
lung nodule
lymph node metastasis
major clinical study
male
multicenter study
outcome assessment
population
positron emission tomography-computed tomography
predictive value
radiation exposure
risk assessment
risk factor
thorax injury
whole body imaging
clinical trial
diagnostic imaging
Italy
risk, Aged
Female
Fluorodeoxyglucose F18
Humans
Male
Positron Emission Tomography Computed Tomography
Risk
Solitary Pulmonary Nodule

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10.1007/s00259-018-4043-y

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Spadafora, M., Pace, L., Evangelista, L., Mansi, L., Del Prete, F., Saladini, G., Miletto, P., Fanti, S., Del Vecchio, S., Guerra, L., Pepe, G., Peluso, G., Nicolai, E., Storto, G., Ferdeghini, M., Giordano, A., Farsad, M., Schillaci, O., Gridelli, C., & Cuocolo, A. (2018). Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial. European Journal of Nuclear Medicine and Molecular Imaging, 45(11), 1908-1914. https://doi.org/10.1007/s00259-018-4043-y

Spadafora, M, Pace, L, Evangelista, L, Mansi, L, Del Prete, F, Saladini, G, Miletto, P, Fanti, S, Del Vecchio, S, Guerra, L , Pepe, G, Peluso, G, Nicolai, E, Storto, G, Ferdeghini, M, Giordano, A, Farsad, M, Schillaci, O, Gridelli, C & Cuocolo, A 2018, 'Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial', European Journal of Nuclear Medicine and Molecular Imaging, vol. 45, no. 11, pp. 1908-1914. https://doi.org/10.1007/s00259-018-4043-y

@article{8b0d65f8fbcb4418960bf2ce7a052c81,

title = "Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial",

abstract = "Purpose: Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and 18F-FDG PET/CT has proven to be more effective than CT alone. Pre-test risk stratification and clinical presentation of SPN could affect the diagnostic strategy. A relevant issue is whether thoracic segmental (s)-PET/CT could be implemented in patients with SPN. This retrospective multicenter study compared the results of FDG whole-body (wb)-PET/CT to those of s-PET/CT. Methods: 18F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. The thoracic part of wb-PET/CT, considered s-PET/CT, was compared to wb-PET/CT. Clinical and PET/CT variables were investigated for SPN characterization as well as for identification of patients in whom s-PET/CT could be performed. Histopathology or follow-up data were used as a reference. Results: In the study population, 36% had malignant, 35% benign, and 29% indeterminate SPN. 18F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. All patients with extra-thoracic metastases (n = 13) had thoracic lymph node involvement and highest 18F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT. Conclusion: Pre-test probability of malignancy can guide the diagnostic strategy of 18FDG-PET/CT in patients with SPN. In subjects with low-intermediate pretest probability s-PET/CT imaging might be planned in advance, while in those at high risk and with thoracic lymph node involvement a wb-PET/CT is necessary. {\textcopyright} 2018, Springer-Verlag GmbH Germany, part of Springer Nature.",

keywords = "fluorodeoxyglucose f 18, aged, Article, cancer risk, cancer test, clinical assessment, clinical effectiveness, cohort analysis, comparative study, controlled study, diagnostic test, distant metastasis, female, follow up, histopathology, human, intermethod comparison, lung metastasis, lung nodule, lymph node metastasis, major clinical study, male, multicenter study, outcome assessment, population, positron emission tomography-computed tomography, predictive value, radiation exposure, risk assessment, risk factor, thorax injury, whole body imaging, clinical trial, diagnostic imaging, Italy, risk, Aged, Female, Fluorodeoxyglucose F18, Humans, Male, Positron Emission Tomography Computed Tomography, Risk, Solitary Pulmonary Nodule",

author = "M. Spadafora and L. Pace and L. Evangelista and L. Mansi and {Del Prete}, F. and G. Saladini and P. Miletto and S. Fanti and {Del Vecchio}, S. and L. Guerra and G. Pepe and G. Peluso and E. Nicolai and G. Storto and M. Ferdeghini and A. Giordano and M. Farsad and O. Schillaci and C. Gridelli and A. Cuocolo",

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year = "2018",

month = oct,

day = "11",

doi = "10.1007/s00259-018-4043-y",

language = "English",

volume = "45",

pages = "1908--1914",

journal = "European Journal of Pediatrics",

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TY - JOUR

T1 - Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial

AU - Spadafora, M.

AU - Pace, L.

AU - Evangelista, L.

AU - Mansi, L.

AU - Del Prete, F.

AU - Saladini, G.

AU - Miletto, P.

AU - Fanti, S.

AU - Del Vecchio, S.

AU - Guerra, L.

AU - Pepe, G.

AU - Peluso, G.

AU - Nicolai, E.

AU - Storto, G.

AU - Ferdeghini, M.

AU - Giordano, A.

AU - Farsad, M.

AU - Schillaci, O.

AU - Gridelli, C.

AU - Cuocolo, A.

N1 - cited By 0

PY - 2018/10/11

Y1 - 2018/10/11

N2 - Purpose: Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and 18F-FDG PET/CT has proven to be more effective than CT alone. Pre-test risk stratification and clinical presentation of SPN could affect the diagnostic strategy. A relevant issue is whether thoracic segmental (s)-PET/CT could be implemented in patients with SPN. This retrospective multicenter study compared the results of FDG whole-body (wb)-PET/CT to those of s-PET/CT. Methods: 18F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. The thoracic part of wb-PET/CT, considered s-PET/CT, was compared to wb-PET/CT. Clinical and PET/CT variables were investigated for SPN characterization as well as for identification of patients in whom s-PET/CT could be performed. Histopathology or follow-up data were used as a reference. Results: In the study population, 36% had malignant, 35% benign, and 29% indeterminate SPN. 18F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. All patients with extra-thoracic metastases (n = 13) had thoracic lymph node involvement and highest 18F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT. Conclusion: Pre-test probability of malignancy can guide the diagnostic strategy of 18FDG-PET/CT in patients with SPN. In subjects with low-intermediate pretest probability s-PET/CT imaging might be planned in advance, while in those at high risk and with thoracic lymph node involvement a wb-PET/CT is necessary. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

AB - Purpose: Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and 18F-FDG PET/CT has proven to be more effective than CT alone. Pre-test risk stratification and clinical presentation of SPN could affect the diagnostic strategy. A relevant issue is whether thoracic segmental (s)-PET/CT could be implemented in patients with SPN. This retrospective multicenter study compared the results of FDG whole-body (wb)-PET/CT to those of s-PET/CT. Methods: 18F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. The thoracic part of wb-PET/CT, considered s-PET/CT, was compared to wb-PET/CT. Clinical and PET/CT variables were investigated for SPN characterization as well as for identification of patients in whom s-PET/CT could be performed. Histopathology or follow-up data were used as a reference. Results: In the study population, 36% had malignant, 35% benign, and 29% indeterminate SPN. 18F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. All patients with extra-thoracic metastases (n = 13) had thoracic lymph node involvement and highest 18F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT. Conclusion: Pre-test probability of malignancy can guide the diagnostic strategy of 18FDG-PET/CT in patients with SPN. In subjects with low-intermediate pretest probability s-PET/CT imaging might be planned in advance, while in those at high risk and with thoracic lymph node involvement a wb-PET/CT is necessary. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

KW - fluorodeoxyglucose f 18, aged

KW - Article

KW - cancer risk

KW - cancer test

KW - clinical assessment

KW - clinical effectiveness

KW - cohort analysis

KW - comparative study

KW - controlled study

KW - diagnostic test

KW - distant metastasis

KW - female

KW - follow up

KW - histopathology

KW - human

KW - intermethod comparison

KW - lung metastasis

KW - lung nodule

KW - lymph node metastasis

KW - major clinical study

KW - male

KW - multicenter study

KW - outcome assessment

KW - population

KW - positron emission tomography-computed tomography

KW - predictive value

KW - radiation exposure

KW - risk assessment

KW - risk factor

KW - thorax injury

KW - whole body imaging

KW - clinical trial

KW - diagnostic imaging

KW - Italy

KW - risk, Aged

KW - Female

KW - Fluorodeoxyglucose F18

KW - Humans

KW - Male

KW - Positron Emission Tomography Computed Tomography

KW - Risk

KW - Solitary Pulmonary Nodule

U2 - 10.1007/s00259-018-4043-y

DO - 10.1007/s00259-018-4043-y

M3 - Article

SN - 0340-6199

VL - 45

SP - 1908

EP - 1914

JO - European Journal of Pediatrics

JF - European Journal of Pediatrics

IS - 11

ER -

Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial

Abstract

Keywords

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